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Year : 2019  |  Volume : 3  |  Issue : 1  |  Page : 104-109

A cadaveric feasibility study for a staged musculocutaneous to medial cord nerve transfer for restoration of hand function following infraclavicular brachial plexus injury

1 Department of Anatomy, University of Birmingham, Birmingham, UK
2 Department of Clinical Neurophysiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
3 Department of Anaesthetics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
4 Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

Correspondence Address:
Mr Daniel N Guerero
Peripheral Nerve Injury Service, Birmingham Hand Centre, University Hospitals NHS Foundation Trust, 6th Floor Nuffield House, Mindelsohn Way, Edgbaston, B15 2WB
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmsr.jmsr_96_18

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Objectives: Axonotmetic medial cord injury results in poor functional hand outcomes due to paralysis of long finger flexors and intrinsic hand muscles. The current management techniques have been reported to yield minimal functional recovery. This study aimed to determine the feasibility of a staged musculocutaneous nerve (MCN) to medial cord nerve transfer using the medial antebrachial cutaneous nerve (MACN) as an in situ reversed vascularized graft for the restoration of hand function in infraclavicular brachial plexus injury. The medial cord targets to be investigated include the nerve to flexor digitorum profundus (FDP), the deep branch of the ulnar nerve (DBUN), and the anterior interosseous nerve (AIN). Methods: Limb measurements were conducted on four fresh cadaveric upper limbs. Each upper limb was dissected by a peripheral nerve surgeon to expose the MACN, the nerve to FDP, the DBUN, and the AIN. The length of the MACN and the distance from the origin of each nerve to recognized forearm bone landmarks were measured. The surgical demonstration of the two-stage nerve transfer was demonstrated on a formalin-fixed upper extremity. Results: The mean graft length of the MACN was 223 mm (range: 179–295 mm). This was sufficient to bridge the calculated mean nerve gap to the nerve to FDP (88 mm, range: 79–101 mm) and DBUN (214 mm, range: 176–247 mm). The mean nerve gap to the AIN (228 mm, range: 201–252 mm) was greater than the mean MACN graft length. Conclusions: Motor nerve transfer of the brachialis muscle branch of the MCN to the medial cord using an interposed MACN graft was shown to allow tension-free neurorrhaphy formation with the nerve to FDP.

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